When you see the words “the business of dentistry” what do you imagine? Perhaps you see a treadmill where high volume and financial reward are the main focus of the dental hygiene department. Or do you see a hygiene department where quality patient care and profitability are congruent, operating with systems and protocols that would not allow one to compromise the other?
A Paradigm Shift
Years ago when I decided to become a dental hygienist a dentist –friend of the family–said to my father, “All my hygienist does is cost my dental office a lot of money! Your daughter should not think about becoming a dental hygienist. Hygienists really don’t add much value to a dental office and I wish I didn’t have a hygienist.” Good thing I didn’t listen to what that man said!!
During the past ten+ years the goal of helping dental patients has now progressed from cleaning teeth into supporting good overall health and preventing disease. One thing that hasn’t changed is the cost of running a dental practice. It is important that the team understand the cost of running a business and also a hygiene department. It is when the team understands these financial aspects of the business that the members of the dental team will be committed to excellence. It is important to have team meetings that educate every team member of the cost associated with the daily operations of running the business of dentistry. Share the vision for your practice and with the team and let everyone, know your mission: The “WHY” you do what you do.
The fact is, the hygiene department is the second largest profit center in the dental practice, and provides support for the practice as a whole. Within the hygiene department are several other areas of profitability for the dental practice.
Most of your patients spend one hour–two to four times a year with the dental hygienist(s) and because of this ongoing relationship patients are more likely to remain in your practice, accept treatment recommendations and refer patients to the dental office. This makes your hygiene department a business within a business. It makes the executive(s) in this department held accountable for his/her success. When the dental hygienist is held accountable for the department success, when he/she understands the vision, and the principles of the dental practice, success will follow. You will find the team working in harmony when they all understand the vision for the practice, share the same code of patient ethics, and take ownership for the way patients are treated.
When every team member takes ownership of their role, the patients are sure to experience a caring attitude, an ultimate dental experience, the highest level of care, and the profits are sure to follow. This provides a win-win situation.
One of the most important aspects of the dental hygiene treatment that is often overlooked, is this list of assessments. (see below) Dental hygienists feel as if they are on a treadmill but when the team effectively plans their day, these assessments can really make the day run smoothly, this will make patients feel they received the highest level of care, and it now allows provides a higher level of comprehensive care. The treatment plan now moves to a higher level of care.
New Treatment Heights
There is a list of 10 assessments and patient procedures that stimulate profitability in the dental hygiene department. (keep reading below) These ten are all important aspects of the patients’ oral and total health. Not all offices participate in this list of 10 and this is what sets your office apart when you offer a menu of these services to your patients.
If you take a look at the list below and notice a missing piece in your dental practice, choose to just implement 1 or 2 of these within the next month. Make an appointment this month to discuss with your team how to implement these ten successfully into the hygiene patient appointment. Be patient with yourself when making these changes. Take time to discuss at a team meeting how to effectively implement these with full participation from the entire team.
The most overlooked assessments are the annual full-mouth periodontal screening exam. Still in the 21st century many hygienists who see a patient every six months, they neglect to pick up a periodontal probe prior to picking up a curette. Most dental offices have approximately 15% of their adult patients with untreated and even undiagnosed periodontal disease. If each of these patients continues down this path we know that the research states — “this disease process will continue and the patient will at some point experience tooth mobility and possible tooth loss.”
What will this cost your dental business? Take into account that most non-surgical periodontal treatment plans are approximately $1,000.00 (USD) for 4 quadrants of scaling and root planing, not taking into account the use of antimicrobials and/or laser therapy. Now take into account the frequency of the periodontal maintenance. (Add in another $100.00 USD maybe 4 times a year.)
Once a periodontal patient, always a periodontal patient. It is the same as a patient with diabetes or high blood pressure. These patients are seen frequently and always at risk for future disease even after the disease has been halted. These patients are asked to schedule a preventive care appointment with their physician to be sure their disease is now “status-quo.” This is no different when our patient is diagnosed with periodontal disease.
Take into account that if you have 100 patients with 6 areas of 5mm pockets and they now receive Phase-1 non-surgical periodontal treatment. And then after the Phase-1 non-surgical treatment is completed the patient returns 4-6 weeks later for the re-evaluation, (Similar to a post-op appointment) which is now considered the 1st periodontal maintenance appointment. If the disease goes untreated we know what the cost to the patient may be tooth loss and poor systemic health. If you neglect this treatment for 100 patients what is the financial loss to your dental business?
Another new area of treatment that is overlooked at this time is the pediatric patient – first visit. CAMBRA (Caries Management by Risk Assessment) is a new evidence-based protocol for assessing caries. It is now the standard of care for the pediatric patient to have their first visit when the first primary tooth erupts. This appointment can be done in a consult room with the child seated on the mothers lap. This is an appointment to assess the tooth structure, biofilm and any suspicious areas of the child’s oral cavity. If you are concerned about receiving payment the CDT codes in the United States have you covered. There are two specific codes to bill for a child to have this exam and bill for the procedure in a consult room, if an operatory is not available. A biofilm assessment, oral hygiene instruction and a fluoride varnish can now be completed in a consultation room and billed accordingly, according to the CAMBRA protocol.
CAMBRA recommends that a patient who is at moderate to extremely high-risk for caries see a dental professional for preventive measures every 90-120 days for biofilm assessment, oral hygiene recommendations, a fluoride varnish and home care instructions; not just at the six month continuing care visit. This adds another area of profit to your dental hygiene department. The Insurance book of CDT codes outlines specific codes to bill various procedures including CAMBRA patients.
How many patients qualify for this preventive measure? How will this benefit your patients and your bottom line? It is all up to you. How will you decide to answer these questions?
When the hygienist and team all understand the need to prevent and intervene at an early stage vs. wait and watch; not only does the patient gain an improved level of health but the dental hygiene production will increase. Establish periodontal and the various preventive protocols today. Now is the time to cease treating the periodontal patient with a prophy appointment and begin to utilize the preventive measures according to the new CAMBRA guidelines.
Another area in dentistry that has changed in the past decade or more is selling home care products. Many decades ago we wrote a prescription or sent our patients to a pharmacy with names of products written on a piece of paper. Our knowledge and research over the past few decades states that 70% of these patients returned to our dental office and never took time to get the prescription filled. Patients seldom took that piece of paper with them to purchase the specific product recommended. When patients have the toothbrush they are to use and shown in the dental office how to use that new power toothbrush they are more likely to use the brush effectively.
This is the one area of your dental practice that has a net profit of about a 70%. You can spend hours preparing a crown or bridge and you have lab fees to pay at the end. The ROI (return on investment) for home care products sold in the dental office is about 70%. We want patients to buy their home care products from the experts, the people who know which toothpaste, toothbrush, mouth rinse, etc., is appropriate for each individual patient to use at home. The sales person at the local drug store and even the pharmacist is not the person to educate a patient about xylitol and its benefits, let alone what type of silica is appropriate to use on the expensive restorations your dental patient just paid for.
By engaging and empowering the entire team, your dental business is certain to excel in many ways. You will create a cohesive team and a dental practice based on excellence and the extraordinary. Realizing the potential of your dental hygiene team and creating a thriving profit center inside this valuable department of your business is essential to building the dental practice you have always dreamed of. This assures you long-term relationships along side your success.
Your team and the dental hygiene department are all very important assets to the health, profitability and success of your dental practice.
10 areas of Profitability in the Dental Hygiene Department
- Perform oral health care assessments that include the review of patients’ health history, dental charting, oral cancer screening, periodontal assessments, biofilm assessment, saliva pH test, smile analysis, xerostomia, etc.
- Expose and interpret dental radiographs (x-rays); co-diagnose
- Non-surgical periodontal procedures, antimicrobial agents, laser therapy, etc.
- Apply cavity-preventive agents such as fluorides varnish and sealants to the teeth;
- Administer local anesthetic and/or nitrous oxide analgesia;
- Educate patients on proper oral hygiene techniques to maintain healthy teeth and gums and recommend home care products
- Discuss whitening treatment and take impressions when applicable
- Administer smoking cessation programs; and
- Counsel patients on the importance of good nutrition for maintaining